Low carbs/keto: they could be useful

[Maxone73]

Just remember: keto diets are NOT high protein diets, they are very low in carbs, average-low in proteins, very very high in fats (esp. extra virgin olive oil, nuts,...)

pubmed.ncbi.nlm.nih.gov/353...

[MoonRocket]

For short durations, I incorporate a keto diet to drop a few pounds. The negative for me is the lack of energy during exercising, especially cardio like running or any kind of HIIT.

[KocoPr]

ah post this in Fight Prostate Cancer group for more targeted responses

[cashlessclay]

Here is another point of view.

mskcc.org/news/research-sho....

[StayingOptimistic in reply to cashlessclay]

Hi, I was just thinking about you a few days back. We had communicated a lot on the other site. How is your psa holding without any treatments?

[cashlessclay in reply to StayingOptimistic]

last PSA was 0.278, after 10.5 years on a 99% plant-based diet.

Cashless

[dhccpa in reply to cashlessclay]

Encouraging. Are you metastatic to bones?

[cashlessclay in reply to dhccpa]

I'm not metastatic to the bones.

Cashless

[dhccpa in reply to cashlessclay]

Great!

[TEBozo in reply to cashlessclay]

How has your weight and muscle mass respond to plant diet? No dairy?

[Maxone73]

Thanks!! we will know more soon hopefully!!

[PCaWarrior]

Most of the research I have seen supports Mediterranean and plant-based diets for PCa.

The article includes this statement: "In a secondary analysis of a randomized trial of low-carbohydrate diet vs. control in men with BCR, serum metabolomics showed that a longer PSA doubling time was associated with higher levels of 2-hydroxybutyric acids, ketone bodies, citrate and malate. These data point to the potential of ketogenesis and Krebs cycle metabolites to slow PC growth, though this requires more study."

I didn't see the raw data but on the surface I have to question this. How much association? 1% or 100%? How many variables were examined? Was it a pre-planned analysis or a brute force, after the fact, possible data-mining exercise?

They also include this statement:

"The obesity paradox in metastatic castration-resistant prostate cancer” [8]. In a secondary analysis using data from the control arms of three phase III randomized trials of metastatic castration-resistant PC (mCRPC), obesity was associated with a lower risk of PC-specific and overall death. These data show that in contrast to findings in early-stage PC, obesity in late-stage PC could be a good prognostic sign, though the mechanisms of this are unclear."

Are the results the same if they exclude men with sarcopenia (risk factor and very common at the end - so a self-fulfilling metric that means absolutely nothing). Are the results the same when muscle mass is normalized? So an obesely fat person does just as good or better than a heavily muscled man? That flies in the face of standard advice, clinical trials, and biology. If this is true, then I will experience a fast late-stage demise unless I shed this life-threatening muscle mass and start putting on fat. I need to start now. I have about 40 lbs of fat to gain before I can proudly claim obesity.

I can see a few other issues in the keto generalization.

PCa is more lipid driven than carbohydrate driven. Only towards the end does it supposedly shift to the typical carbohydrate driven cancer type.

What stage were these guys at? BCR so possibly CRPC and some of them might have been far along that path. Is some of the increase in PSADT due simply to weight loss? If so, would a reduced calorie plant-based diet be superior? Edit: I re-read part of it and some or all of these men had metastatic CRPC.

Another thing to keep in mind is that many men, regardless of therapy, have increases in PSADT over time. This should be kept in mind when looking at results from any therapy or supplement.

ncbi.nlm.nih.gov/labs/pmc/a... “in the RCT placebo cohort; 46% of patients experienced PSADT increases >200%”, “These data suggest that calculated PSADT in BRPC may naturally increase over time in the absence of therapy and may be influenced by duration of PSA follow-up. As a result, single arm trials could show false significant increases despite the lack of active treatment of these patients. Placebo-controlled RCTs including clinical endpoints are recommended to screen novel agents in men with BRPC to mitigate bias because of natural PSADT variability.”

I gravitate to a plant-based diet with chicken and salmon. And 50-100 grams of whey protein every day. My MO thinks that there is something behind intermittent fasting and recommends an eating window of 10 hours a day for maximum benefit (she doesn't like long term fasting since sarcopenia is a proven risk). I eat in a 6-10 hour window. Sometimes as low as four hours. If I'm hungry, I eat.

Research, trials, data, and the medical oncologists I have asked overwhelmingly favor muscle gain/fat loss over any type of dietary restriction/addition. I have yet to hear an MO tell me that obesity is the answer.

My MO ranks diet as having a mediocre impact on PCa. When I asked her about exercise she practically jumped out of her chair and yelled 10! I focus on body composition and happiness far more than dietary unpleasantness.

[maley2711 in reply to PCaWarrior]

For happiness, a good pie with coffee? Maybe some ice cream to top it off?

[PCaWarrior in reply to maley2711]

Follow whatever your goals are. If you are trying to prevent sarcopenia, eat whatever you can.

[Maxone73 in reply to PCaWarrior]

All more than valid points, we will have the answers soon enough. But you could even have both: a keto diet based on plants. Personally I am 90% vegan, but would be good if they get some results from the various trials on different diets.

As for me, I have been exposed to mediterranean diet my whole life being italian and having a mother that still loves to cook and to work in the garden at almost 95 of age.

But of her 4 kids, I am the youngest (by far, my older bro is 18 years older than I) I am the only one that was not spared cancer, in spite of being the most active in sports with a past, and maybe a present (been asked to do it again) as personal trainer and natural bodybuilder, but you already know this part of my story. I know for a fact that training is the number one weapon we have (apart from the various therapies of course).

But the other part of my person (the AI researcher/matematician) knows very well what a "marginal gain" is. As in competitive sports, the difference from winning and losing is not huge but a sum of small margins. And I am not leaving any 0.2 % unattempted on the table even if it means going keto-vegan. As you know I am rather cautious with animal proteins supplements, excess of proteins and, lately, with creatine (till I get better info), but I have no problems integrating veg proteins in my diet.

Apart from that, I still enjoy a good complete meal once in a while, with one of the great wines of my area, with my closest friends (but had to lie to my mom about some diet I have to do for diabetes, as if she knew I got cancer she would go out of her mind).

[Kaliber in reply to Maxone73]

for 25 years before I was diagnosed, I was a “ hard core “ keto dieter for other health reasons. 50 carbs and 1000 calories a day. Mostly vegan.

Then I was DXed with pa’ve Mets , 1400 psa, hospice recommended. In my case I could wonder if those decades of keto caused / contributed to my aPCa. In my case , evidently it either had no effect or even caused / helped me to develop aPCa.

Just say’in

[Maxone73 in reply to Kaliber]

wow, 1000 Kcals per day???? It's hard enough to do a keto-vegan diet, but 1000 calories?

[Kaliber in reply to Maxone73]

Yea , no kidding. Eventually you get used to it and some imaginative cooking helps too. ( and some pills from down on the corner ) On keto, you still can snack on anything cheese or meat as much as you need and most things won’t run up your calorie count up all that. Frankly , for me, I don’t care about the calories all that much these days , but I “ still “ have to play the keep the blood sugar ( carbs ) down … stupid game.

[PCaWarrior in reply to Maxone73]

Watch out for the vegetarian proteins. I went that way for a few months but then started researching and found the most vegetarian proteins are loaded with heavy metals. Whey seems to be by far the cleanest (vanilla or unflavored if you want the 0.2%). It also has some speculative PCa therapeutic properties.

I don't know of any study that has looked at vegetarian-keto. I did this diet a few years back. It made no discernable difference to my PSA. That could be good though - it didn't cause much increase.

[Maxone73 in reply to PCaWarrior]

Some are high in heavy metals, correct. Of course it also depends on the primary source. But when I read about whey (I will soon post something about it) there are studies that say they may help...other studies that say that they promote dissemination of metastasis. Glutathione is a double sword they say, but I still have to study it to balance the good and the bad. I suppose in the meantime a modest integration of whey would not hurt.

[PCaWarrior in reply to Maxone73]

I might have sent you the study? I post the good and the bad. I found 4 positive studies and 1 negative. An additional one sort of seemed negative to me if you connect the dots.

My take is that it probably doesn't make a lot of difference. Cell studies and crude observational risk prevention.

What is a clean source of vegan protein? Pea appears to be better than most.

What is proven is cachexia is bad. Muscle mass, strength, and exercise are good. I opt for the proven vs. the speculative. And if in doubt, I do what makes me happiest.

[Maxone73 in reply to PCaWarrior]

No, I think the one you sent was about creatine and metastasis. I am trying to play by the book....while there is no book! (apart from the obvious)

[PCaWarrior in reply to Maxone73]

Hard to figure this out using lower quality data. I like using cinicaltrials.gov and talking to medical experts.

1. Mouse study: Inhibition of rate of tumor growth by creatine and cyclocreatine. - PMC

ncbi.nlm.nih.gov/labs/pmc/a...

2. Mouse study: Creatine powers T cells’ fight against cancer | UCLA

newsroom.ucla.edu/releases/...

3. Mouse study: Creatine in T Cell Antitumor Immunity and Cancer Immunotherapy – PMC

ncbi.nlm.nih.gov/pmc/articl...

4. The two sides of creatine in cancer – ScienceDirect

sciencedirect.com/science/a...

5. Role of Creatine Supplementation in Conditions Involving Mitochondrial Dysfunction: A Narrative Review – PMC

ncbi.nlm.nih.gov/pmc/articl...

6. Energy metabolism of cancer: Glycolysis versus oxidative phosphorylation (Review) – PubMed

pubmed.ncbi.nlm.nih.gov/232...

7. Mouse study: Creatine promotes cancer metastasis through activation of Smad2/3

cell.com/cell-metabolism/pd...

8. Creatine uptake regulates CD8 T cell antitumor immunity | Journal of Experimental Medicine | Rockefeller University Press

rupress.org/jem/article/216...

So, inhibits tumors and promotes tumors. Promotes T-cells and immunity. Bottom line: clear as mud. Until a clinical trial reports out, I'm using creatine.

We are 99.9% confident that muscle mass and strength help.

[maley2711]

Or they could not be?

[tunybgur]

PCa cells do consume lots of carbs to grow so limiting carbs is a sensible strategy, but tests have shown that calorie restriction is more effective.

PCa cells have ways of circumventing carb restriction by stealing carbs from other sources, but calories are more difficult to obtain, the problem is we need some calories to live.

I have advanced PCa, and tend to avoid simple carbs, sugar, pasta, rice, potatoes, bread, some sweet fruits, and most dairy. I max out on protein esp chicken, fish, eggs, soy drinks (unsweetened), beans and pulses, and lots of green veggies, esp cruciferous, and protein drinks etc.

The only exception I make is wholewheat bread, I do eat sandwiches and have a couple of slices every day, can't live without my chicken and avocado sarnies!

Good luck

[Graham49]

What diet is best for prostate cancer might be more to do with the resulting microbiome than whether it’s Keto, low carb or plant based. It is early days for research in this area, but so far it looks promising.

The Gut-Prostate Axis: A New Perspective of Prostate Cancer Biology through the Gut Microbiome

by Kazutoshi Fujita 1,*, Makoto Matsushita 2, Marco A. De Velasco 3ORCID, Koji Hatano 2, Takafumi Minami 1, Norio Nonomura 2 and Hirotsugu Uemura 1ORCID

1 Department of Urology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan

2 Department of Urology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan

3 Department of Genome Biology, Kindai University Faculty of Medicine, Osakasayama 589-8511, Japan

Cancers 2023, 15(5), 1375; doi.org/10.3390/cancers1505...

Received: 4 January 2023 / Revised: 3 February 2023 / Accepted: 20 February 2023 / Published: 21 February 2023

(This article belongs to the Special Issue Metastatic Prostate Cancer: Interaction with Tumors and Their Microenvironments)

Simple Summary

The gut microbiome plays important roles in the development of several diseases. The gut microbiome is a dynamic system that is affected by several factors, such as dietary habits, and since prostate cancer and diet are closely linked, it is reasonable to hypothesize that a gut microbiome—affected by diet—could regulate prostate cancer far from the gut, thus creating a gut-prostate axis. Gut dysbiosis result in the leakage of gut bacterial metabolites, such as short-chain fatty acids and lipopolysaccharide into the systemic circulation, leading to the prostate cancer growth. Patients with prostate cancer have a distinct gut microbiome. Furthermore, the gut microbiome produces androgen, affecting castration-resistance of prostate cancer. The gut-prostate axis could be a new target for the prevention and management of human prostate cancer.

Abstract

Obesity and a high-fat diet are risk factors associated with prostate cancer, and lifestyle, especially diet, impacts the gut microbiome. The gut microbiome plays important roles in the development of several diseases, such as Alzheimer’s disease, rheumatoid arthritis, and colon cancer. The analysis of feces from patients with prostate cancer by 16S rRNA sequencing has uncovered various associations between altered gut microbiomes and prostate cancer. Gut dysbiosis caused by the leakage of gut bacterial metabolites, such as short-chain fatty acids and lipopolysaccharide results in prostate cancer growth. Gut microbiota also play a role in the metabolism of androgen which could affect castration-resistant prostate cancer. Moreover, men with high-risk prostate cancer share a specific gut microbiome and treatments such as androgen-deprivation therapy alter the gut microbiome in a manner that favors prostate cancer growth. Thus, implementing interventions aiming to modify lifestyle or altering the gut microbiome with prebiotics or probiotics may curtail the development of prostate cancer. From this perspective, the “Gut–Prostate Axis” plays a fundamental bidirectional role in prostate cancer biology and should be considered when screening and treating prostate cancer patients.

[Maxone73 in reply to Graham49]

AH! I am with you with that. Fermented vegetables, pomegranate fruit and juice and so on. I am doing it. I forgot to say it before but yes, our immune system is very important and it's located mainly in our gut.

[Graham49 in reply to Maxone73]

I am a bit dubious about the juice. High in sugar and low in fibre could feed the wrong types of bacteria in your gut.

[Maxone73 in reply to Graham49]

It's fresh juice, no sugar. I buy it at the supermarket but they have to store it in the fridge. It does not taste good and it gets even worse after few days (I have pomegranates on a tree outside the door, but not all year round)

[glgr in reply to Graham49]

Great info. Thanks!